Published online Mar 7, 2016. doi: 10.3748/wjg.v22.i9.2828
Peer-review started: September 1, 2015
First decision: October 15, 2015
Revised: November 4, 2015
Accepted: November 24, 2015
Article in press: November 24, 2015
Published online: March 7, 2016
AIM: To identify the possible predictors of early complications after the initial intervention in acute necrotizing pancreatitis.
METHODS: We collected the medical records of 334 patients with acute necrotizing pancreatitis who received initial intervention in our center. Complications associated with predictors were analyzed.
RESULTS: The postoperative mortality rate was 16% (53/334). Up to 31% of patients were successfully treated with percutaneous catheter drainage alone. The rates of intra-abdominal bleeding, colonic fistula, and progressive infection were 15% (50/334), 20% (68/334), and 26% (87/334), respectively. Multivariate analysis indicated that Marshall score upon admission, multiple organ failure, preoperative respiratory infection, and sepsis were the predictors of postoperative progressive infection (P < 0.05). Single organ failure, systemic inflammatory response syndrome upon admission, and C-reactive protein level upon admission were the risk factors of postoperative colonic fistula (P < 0.05). Moreover, preoperative Marshall score, organ failure, sepsis, and preoperative systemic inflammatory response syndrome were the risk factors of postoperative intra-abdominal bleeding (P < 0.05).
CONCLUSION: Marshall score, organ failures, preoperative respiratory infection, sepsis, preoperative systemic inflammatory response syndrome, and C-reactive protein level upon admission are associated with postoperative complications.
Core tip: Intra-abdominal bleeding, colonic fistula, and progressive infection are the three major early post-procedural complications in patients with acute necrotizing pancreatitis regardless of the selected approach. Possible predictors, accurate diagnosis, and appropriate management methods are beneficial to decrease the mortality rate and convalescence, as well as promote the life quality of patients with acute pancreatitis. In this study, Marshall score, organ failures, preoperative respiratory infection, sepsis, preoperative systemic inflammatory response syndrome, and C-reactive protein level upon admission are associated with post-procedural complications. Proper and gentle intervention process, and close monitoring and evaluation of patients who are prone to suffer from postoperative complications may increase the therapeutic efficiency.